Friday, 13 January 2017

What to expect when visiting A&E for Self-Harm

Disclaimer: To be honest, this is a rather scary post for me to write as it would be impossible to write without sharing my own experiences and does put me in a slightly vulnerable position. I am in no way, shape or form declaring that self-harm that needs treatment is more important than self-harm that does not but I have been told that writing about this subject would be helpful and beneficial to some individuals. Please don't read this post if you're feeling vulnerable or in a bad place as I do not intend to cause harm to any of you. I understand that often, individuals are mistreated in A&E but this post is talking about what should happen to the best of my knowledge.

The self-harm cycleSelf-Harm is a very serious topic which has been on the rise among (mostly) young people over the recent years in fact, nowadays "10% of young people self-harm". In case you aren't aware; self harm is when an individual causes deliberate harm to themselves, usually caused by emotional pain and suffering. There are many different ways in which individuals may self-harm but one of the most common is cutting. There could be a range of reasons to why an individual may turn to self-harm but it is a general fact that as time goes on, self-harm gets worse and worse and unfortunately, for many people who haven't managed to stop will continue to the point of needing treatment.

Going to your local A&E department for the first time for self-harm can be extremely daunting, you may feel ashamed or lost when in reality, doctors see it every single day. Before going to A&E, I would recommend telling somebody close to you like a relative or a friend and seeing if they are able to come with you to make you feel less anxious. When you arrive, the receptionist will ask you a series of questions including your personal details and for what reason you are attending the hospital and unfortunately there is no way of avoiding the subject because even though telling them that you have a cut that needs seeing to, they will then ask how it happened and you will need to tell them that it was self-harm. Despite being receptionists, they still have a duty to care and will not belittle you or judge you as like I said, this is a regular occurrence for them. You will be asked to take a seat in the waiting room and I would definitely recommend taking a book or downloading a game on your phone to play as there will be a long wait. 

At this point, I can only talk from experience in one hospital but I assume that they all work the same way. Fairly soon after being seated, you will be called into a side room by a nurse for assessment where they will need to see the wound, ask more specifically how it happened, how you are feeling, if you are in services and will redress the wound. At this point, they pass your paperwork to a doctor and the waiting game starts again. You will either remain in the A&E waiting room or be moved to a minor injuries department waiting room and wait you turn. This can be anything from an hour to six hours; depending on how busy they are. 

You will be called through to a room or bay where a doctor will ask to see the wound and decide how to treat it. All doctors are different and different doctors like to use different methods to close a wound. They will usually either use steri-strips, also known as butterfly stitches which are thin paper strips that hold the wound edges together, skin adhesive, known as skin glue to seal the wound closed, stitches (sutures), either absorbable/disolvable or non-absorbable or skin staples; they all sound much scarier than they actually are. Before any wound is closed, the doctor will thoroughly clean the wound which can sometimes sting to avoid the risk of infection. Doctors only like to close wounds between six and eight hours after the incident happened due to infection risks and as the wound could have already started to heal so the sooner you can seek treatment, the better.

Steri-Strips - These are the least painful option out of the three and can be used on any wounds that are open (where the two edges of skin have come apart). They are the most preferred type of closure by doctors as they don't leave extra scarring. However, occasionally a wound may be too wide for steri-strips to hold and therefore a different method would be used. These strips are essentially tiny, long plasters that hold the wound together and it is recommended that they stay on the wound between three and five days although this often depends and the doctor treating you will tell you otherwise. Due to these being made essentially from paper, it is important that they don't get wet whilst they are on as this could cause them to become unstuck and the wound reopening. 

Skin Glue - When a wound is glued, steri-strips are usually used to support the wound whilst it is being glued. The glue will be applied directly to the opening of the wound and will act as a seal whilst the wound heals. I find that skin glue can sting a little but not much at all. It is important to leave the wound and glue alone whilst the wound is in the healing process as if it comes off, it can cause the wound to reopen.

Sutures/Stitches - As I said before, either disolvable or non-disolvable stitches would be used. Disolvable stitches are a very light white/translucent colour and are made of a material that allows them to disappear on their own and will often fall out eventually. The most common form of stitches are non-disolvable which are blue and will need to be removed by your local GP usually between 7-10 days. Whenever stitches are used, local anesthetic (numbing injection) will be used and the doctor will ask you multiple times if you are able to feel what he is doing. All doctors using stitches have been trained and different doctors will use different methods of stitching so if you feel that your stitches look odd, then don't panic. In some cases, a wound may require both internal and external stitches; internal stitches being disolvable. If this is the case, then anesthetic will be put inside the wound as well as outside and I'm not going to lie, it does sting but it soon goes numb. The amount of stitches received depends on the length of the wound and the doctors preference as some doctors like to add a couple extra to try and reduce scarring as much as possible. After you have received your stitches, the wound will be cleaned again and a dressing will be applied. A few hours later, the wound may start to hurt due to it being tugged around with stitches but painkillers can help with this. It is also important that you don't get your stitches wet as it can affect the healing process. With stitches, the area around the wound does usually bruise, sometimes worse than others depending on the area and dotted scarring usually occurs.

Staples - In my opinion, receiving staples were the scariest of all four methods. I was told that usually local anesthetic isn't giving as it is a quick process however, I request it because the pain was ridiculous and yes I am aware that I caused myself pain in the first place but that it a whole different subject. They use surgical staples and are applied with a staple gun which is the worse part although like I said before, if you request anesthetic, you wont feel a thing. Like stitches, the doctor will include enough staples to ensure that the wound doesn't reopen. Staples are usually used as a last resort as they are the strongest type of closure but it does depend on the doctor. A dressing will be put over the wound and they cannot get wet as they are metal and could cause rusting or infection. These will need to be removed by your local GP and the doctor will tell you how long they should remain in for. This method is also likely to leave bruises and will often leave dot scarring from where they have been in the skin.

After you have been seen to, your doctor will either risk assess you or ask you to wait to see the crisis team who can find out and understand more about what happened and why. Usually doctors are nice but if going to A&E becomes a regular occurrence which I really hope it doesn't, you're bound to find some who aren't so friendly and very misunderstanding but it really isn't worth listening to them and letting them get you down as they've probably acted in that way with all of their patients of the day. The A&E department will have to contact your care team of the service that you are in to make sure that a follow up appointment is made. You will receive a small booklet, usually either named 'Wound Care' or 'Deliberate Self-Harm' which will have all of the information that you will need about your treatment and what you have to do next. 

Going to the hospital and receiving support or treatment for a wound is always the best idea if you or somebody else believes that it is requires and you will never be turned down by a doctor as their duty is to reduce scarring as well as the risk of infections which could be dangerous lead to very serious complications and can also speed up the healing process. No matter what type of closure you have received you should keep a bandage on as if not, you will catch it on something and it will hurt. 

If you need immediate help or support then don't hesitate to visit your local A&E department to speak to the on call psychiatrist, or alternatively call the Samaritans - 116123 or ChildLine - 08001111. For more information as to whether your wound needs treatment visit the NHS website here for accurate and professional information.

I hope that this post is beneficial to at least one of you and never be afraid to reach out for support. If you would like me to write about any similar topics, whether that be distraction techniques or more facts about self-harm then leave me a comment and I will get back to you as soon as possible.

Thank-you for reading, Tay x

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